DOUGHNUTSDOUGHNUTS. Opioid Agonist Therapy The Skinny on Methadone et al.
Opioid Therapy Management Tools for Success Library/Document Library... · Opioid Therapy...
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Opioid Therapy Management Tools for Success Healthesystems provides a comprehensive opioid management program that is fully integrated into our highly successful workers’ compensaon Pharmacy Benefit Management soluon. Powered by VigilantRx — the Healthesystems clinical program — this evidence based soluon combines proprietary medicaon therapy management tools with easy to use technology tools to drive immediate detecon and intervenon of problemac opioid treatments. The mul- ered program includes a suite of tools and protocols that proacvely manage new claims during the inial stage of opioid therapy, in addion to the older and more costly chronic pain claims populaons. The use of opioids for treang workers’ compensaon claimants can comprise anywhere from 20% - 40% of an insurance payer’s prescripon drug cost and the escalang number of cases experiencing abuse, misuse and addicon has quickly spiraled to epidemic proporons. Focusing on early detecon and intervenon of inappropriate or excessive treatments is a crical requirement for increasing paent safety, lowering prescripon drug costs and improving overall treatment outcomes. The opioid management program monitors mulple stages of opioid drug therapy and is capable of systemacally idenfying cases where addional tools such as treatment reviews, physician outreaches and drug toxicology screenings are necessary. Real me protocols are applied to idenfy various treatment red flags such as mulple prescribers, extended duraon of treatment, and escalang morphine equivalent daily dose (MED) levels, along with many other evidence based opioid treatment criteria. Program results have shown significant improvements in drug therapy outcomes including cost savings and overall reducon in opioid use. Further detailed analysis have shown that claimant populaons monitored by the program maintain average MED levels that are over 30% less than claims not being monitored — thus significantly reducing the costs and risks associated with higher dose opioid therapies. Addional analysis have shown a 40% reducon in the total number of prescribing physicians aſter claims were implemented into the program. lower AVG. MED/patient 30 Opioid Therapy Management E D U C A T I O N E V I D E N C E B A S E D O U T C O M E M O N I T O R I N G P A T I E N T S A F E T Y O U T R E A C H M U L T I P L E M D ’ S M U L T I P L E O P I O I D R X ’S M E D E S C A L A T I O N D U R A T I O N O F T R E A T M E N T I N I T I A L / O N G O I N G T H E R A P Y R E A L - T I M E M O N I T O R I N G P R E V E N T I O N S T R A T E G I E S N E W D R U G M O N I T O R N I N G E A R L Y I N T E R V E N T I O N COMMON TRIGGERS AND ALERTS (AND OTHER PAYER-DEFINED RULES) ALERTS & INTERVENTIONS CLINICAL ENGAGEMENT PharmD Outreach Case Management Peer to Peer Evaluation Urine Drug Screening Cognitive Behavior Therapy And More 40 Reduction of prescribers
Transcript of Opioid Therapy Management Tools for Success Library/Document Library... · Opioid Therapy...
Opioid Therapy Management Tools for Success
Healthesystems provides a comprehensive opioid management program that is fully integrated into our highly successful workers’ compensation Pharmacy Benefit Management solution. Powered by VigilantRx — the Healthesystems clinical program — this evidence based solution combines proprietary medication therapy management tools with easy to use technology tools to drive immediate detection and intervention of problematic opioid treatments. The multi-tiered program includes a suite of tools and protocols that proactively manage new claims during the initial stage of opioid therapy, in addition to the older and more costly chronic pain claims populations.
The use of opioids for treating workers’ compensation claimants can comprise anywhere from 20% - 40% of an insurance payer’s prescription drug cost and the escalating number of cases experiencing abuse, misuse and addiction has quickly spiraled to epidemic proportions. Focusing on early detection and intervention of inappropriate or excessive treatments is a critical requirement for increasing patient safety, lowering prescription drug costs and improving overall treatment outcomes. The opioid management program monitors multiple stages of opioid drug therapy and is capable of systematically identifying cases where additional tools such as treatment reviews, physician outreaches and drug toxicology screenings are necessary. Real time protocols are applied to identify various treatment red flags such as multiple prescribers, extended duration of treatment, and escalating morphine equivalent daily dose (MED) levels, along with many other evidence based opioid treatment criteria. Program results have shown significant improvements in drug therapy outcomes including cost savings and overall reduction in opioid use. Further detailed analysis have shown that claimant populations monitored by the program maintain average MED levels that are over 30% less than claims not being monitored — thus significantly reducing the costs and risks associated with higher dose opioid therapies. Additional analysis have shown a 40% reduction in the total number of prescribing physicians after claims were implemented into the program.
lower AVG. MED/patient
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Opioid Therapy Management
EDUCATION
EVIDENCE BASED
OUTCOME MONITORING
PATIENT S
AFET
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UTREACH
M
ULTI
PLE M
D’S
MULTIPLE OPIOID RX’S
MED ESCALATION DURATION OF TREATMENT INITIAL/ ONGOING THERAP
Y
REAL-TIME MONITORING
PREVENTION STRATEGIES NEW DRUG MONITORN
ING
E
ARLY
INTE
RVENTION
COMMON TRIGGERS AND ALERTS
(AND OTHER PAYER-DEFINED RULES)
ALERTS &INTERVENTIONS
CLINICAL ENGAGEMENTPharmD OutreachCase Management
Peer to Peer EvaluationUrine Drug Screening
Cognitive Behavior TherapyAnd More
OPIOID THERAPY MANAGEMENT OVERVIEW
4 KEY STEPS TO REDEFINE AN OPIOID MANAGEMENT STRATEGY
REFOCUS TREATMENT GOALS
DEPLOY PRECISELY TIMED TOOLS
ACCESS SYSTEMS & CLINICAL EXPERTISE
>Focus on recovery & functional improvement, not pain>Adopt current opioids guideline>Incorporate alternative therapies
>Assemble a suite of alerts, letters, contracts, interventions & other tools>Determine when and how each will be deployed & by whom
>Use evidence-based guidelines to drive opioid approvals >Approve alternative therapies, when appropriate >Set triggers for case and therapy reviews, interventions & claims escalation
>Employ state-of-the-art information systems>Access well-trained claims professionals>Consult with clinicians when needed
ESTABLISHNEW POLICIES & PROCEDURES
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40 Reductionof prescribers
About Healthesystems Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. Our comprehensive products include a leading Pharmacy Benefit Management (PBM) Program, expert Clinical Review Services and a revolutionary Ancillary Benefits Management (ABM) solution for prospectively managing ancillary medical services.
Our Verticē Claims Information Portal delivers real-time pharmacy and ancillary benefit management program information, reports and tools. This intuitive web portal allows claims professionals to access tools for quickly and efficiently processing provider transactions, running reports, retrieving relevant clinical information and many other functions.
By leveraging powerful technology, clinical expertise and enhanced workflow automation tools, we provide clients with flexible programs that reduce the total cost of medical care and manage drug utilization, including the overuse of opioids and other problematic drugs, all while increasing the quality of care for injured workers.
Real time tools for real world situations
Healthesystems plays a key role in the early detection of potentially problematic opioid use. A series of real-time alerts and notifications aimed at informing prescribers, claims professionals and other key stakeholders of opioid use are employed using criteria such as dosage level, type of drug, and duplicate therapies, among others. A comprehensive opioid management strategy is only successful when it is proactive. Early detection and early intervention are proven to alter the costly and often unproductive path opioid treatments frequently follow.
To support this process, Healthesystems has developed a proprietary tool to identify a claimant’s current risk level of an existing opioid therapy regimen. The electronic tool — named OpioidRx RISC Score (Real-time Indicator & Severity Calculation score) — is integrated into the Healthesystems online web portal program Verticē. Here claims professionals can analyze the risk level associated with a claimant’s opioid treatment, which is based upon the MED valuation and other factors of all current drug therapies. Claims professionals can use the tool in real-time as part of an integrated prior authorization review process.
Ongoing monitoring and performance measurement
The Healthesystems opioid management program provides proactive and ongoing oversight of injured workers receiving opioid therapy and notifies payers of potential issues such as inappropriate therapy, abuse and misuse each step of the way. The opioid management program fosters communication between all parties involved — payer and/or claims professional, prescribing physician, Healthesystems clinical pharmacist and the patient if necessary. Electronic alerts and message protocols are integrated into the prior authorization process and communication escalations can be automatically routed to various stakeholders depending on client defined therapy criteria. Most importantly, Healthesystems monitors all communications — electronic authorizations, telephonic conversations, mail correspondence and prescriber feedback — and measures the resulting outcomes.
5100 West Lemon StreetSuite 311Tampa, FL 33609800.921.1880 l Toll Free800.758.5779 l Customer Service Center800.964.1681 l Drug Information Linewww.healthesystems.com
©2014 Healthesystems. 042414
Early intervention
rX TOOLS PRODUCE LONG TERM
RESULTS
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